Quacks and Grafters Part 3

His rival, perhaps from the same college, tells the people that typhoid must "run its course" and cannot be broken up, and that any man who claims the contrary is a liar and a shyster. One surgeon makes a portion of the people believe he has saved dozens of lives in that community by surgical operations; the other physicians of the town tell the people openly, or at least hint, that there has been a great deal of needless butchery performed in that community in the name of surgery. And then the people see editorials in the daily press about the fad of having operations performed, and read in their health culture or Osteopathic journals from articles by the greatest M.D.s, in which it is admitted that surgery is practiced too largely as a graft. Professor Osler is quoted as saying:

"Surgeons are finding altogether too many cases of appendicitis these days. Appendicitis is becoming so common and so easily detected that the physician's wife can diagnose a case of it over the telephone."

One leading physician says medical treatment has little beneficial effect on pneumonia; another claims to be able to cure it, and lets the friends of his patient rely entirely on his medicine in the most desperate cases.

Another says the main reliance should be heat. Another says ice-packs.

Another says Antiphlogistine. Another says, "All those clay preparations are frauds, and the only safe way to treat pneumonia is by blood letting."

Thus it goes, and this is only a sample of contradictions that arise in the treatment of diseases.

Nor is the above an overdrawn picture. Most of it was from the journal of the editor who said he refused to send it to a layman who had sent his money in advance. But all that same stuff has been hashed and rehashed to the people through the sources I have already mentioned. There are not only these evidences of inconsistencies to edify (?) the people, but constantly recurring examples of incompetency and pretensions.

There is no doubt a middle ground in all this, but it is not evident to the casual observer. If the true physician would honestly admit his limitations to the intelligent laity, much of this muddle would be avoided. While by such a course he may occasionally temporarily lose a patient, in the end both the public and profession would gain. The time has gone by to "a.s.sume an air of infallibility toward the public."

CHAPTER V.

THE EXPERT WITNESS AND PROPRIETARY MEDICINES.

The "Great Nerve Specialist"--The Professional Witness a Jonah--The "Railway Spine"--Is it Lack of Fairness and Honesty or Lack of Skill and Learning?--Destruction of Fine Herds of Cattle Without Compensation--Koch's Dictum and Denial--Koch's Tuberculin--The Serum Tribe--Stupendous Sale of Nostrums--Druggist's Arguments--Use of Proprietary Medicines Stimulates Sale of Nostrums.

I wonder what the patrons of the sanitarium of the "great nerve specialist" thought of his display of knowledge of the nervous system when he was on the witness stand in a recent notorious case? A lawyer tangled him up completely, and showed that the doctor had no accurate knowledge of the anatomy of the nervous system. When asked the origin of the all-important pneumogastric nerve, he _thought_ it originated in a certain segment of the spinal cord! This noted "specialist" was made perfectly contemptible, and the whole profession must have blushed in shame at the spectacle presented. And that spectacle was not unnoticed by the intelligent laity.

The professional witness has in most cases been a Jonah to the profession.

It is about as easy to get the kind of testimony you want from a professional witness in a suit for damages for personal injuries as it is to get a doctor's certificate to get out of working your poll-tax, or a certificate of physical soundness to carry fraternal life insurance.

Let me recall the substance of a paper read a few years ago by perhaps the greatest lawyer in Iowa (afterward governor of that State). He told of a trial in which he had examined and cross-examined ten physicians. It was a trial in which suit was brought to recover damages for personal injury, a good ill.u.s.tration of the "railway spine." One physician testified that the patient was afflicted with sclerosis of the spinal cord; another said it was a plain case of congestion of the cord; another diagnosed degeneration of the cord; yet another said it was a true combination of all the conditions named by the first three. They all said there was atrophy of the muscles of the left leg, and predicted that complete paralysis would surely supervene.

On the other side five noted physicians testified as positively that neither the spinal cord nor any nerve was injured; that there was no sign of atrophy or loss of power in the leg; and they seemed to think the disease afflicting the patient was due to a fixed desire to secure a verdict for large damages from the railway company. One eminent specialist made oath that the electrical test showed the partial reaction of degeneration; another as famous challenged him to make the test again in the presence of both. After it was made this second specialist went before the jury and positively declared that there was no trace whatever of the reaction of degeneration, and that the muscles responded to the current precisely as healthy muscles should.

Then this eminent attorney adds: "If the instances of such diversity were rare they might pa.s.s unnoticed, but they occur and re-occur as often as physicians are called to the temple of justice for the expression of opinions."

The lay mind imputes this clash of opinions either to lack of fairness and honesty or lack of skill and learning. In either case the profession suffers great injury in the estimation of those who should have for it only the profoundest admiration and the most implicit faith. Again I ask, Is it any wonder people have lost implicit faith when they read many reports of similar cases rehashed in the various yellow journals put into their hands?

Farmers submitted with all possible grace to the decrees of science when, by the authority of such a great man as Koch, their fine herds of cattle were condemned as breeders and disseminators of the great white plague and destroyed without compensation. But how do you think these same farmers feel when they read in yellow journals that Koch has changed his mind about bovine and human tuberculosis being identical, and has serious doubts about the one contracting in any way the disease of the other.

People read with renewed hope the glowing accounts of the wonderful achievements of Dr. Koch in finding a destroyer for the germ of consumption. Somehow time has slipped by since that renowned discovery, with consumption still claiming its victims, and many physicians are saying "Koch's great discovery is proving only a great disappointment."

Drugless therapy journals are continually pouring out the vials of their wrath upon vaccination, ant.i.toxin and all the serum tribe, and their vituperation is even excelled by vindictive denunciations of the same things by the individual boomer journals that flood the land.

Another bitter contention that is confusing some, and disgusting others, is the acrimonious strife between users and non-users of proprietary medicines. This usually develops into a sort of "rough house" affair, the druggist mixing up as savagely as the doctors before the fight is finished. I know nothing of the rights or wrongs of the case nor of the merits or demerits of proprietary medicines, but I do know this, however: The stupendous sale of nostrums that in 1907 represented a sum of money sufficient to have provided every pract.i.tioner of medicine in the United States with a two thousand dollar salary, has been helped by the use of proprietary medicines. I am aware that my position is likely to be called in question by many physicians. But they should hear druggists arguing with people who hesitate about buying patent medicines because their physicians tell them they should seldom take medicine unless prescribed by a doctor. They would hear him say: "Your doctor gives you medicines that are put up in quant.i.ties for him just as these patent medicines are put up for us." He then produces literature and proves it--at least beyond the refutation of the patient. Physicians would then realize, perhaps, how the use of proprietary medicines stimulates the sale of nostrums.

CHAPTER VI.

FAITH CURE AND GRAFT IN SURGERY.

Suggestive Therapeutics Chief Stock in Trade--Advice of a Medical College President--Disease Prevention Rather than Cure--Hygienic Living--The Medical Pretender--"Dangerous Diagnosis" Graft--Great Flourish of Trumpets--No "Starving Time" for Him--"Big Operations"--Mutilating the Human Body--Dr. C. W. Oviatt's Views--Dr.

Maurice H. Richardson's Incisive Statements--Crying Need for Reform--Surgery that is Useless, Conscienceless and for Purely Commercial Ends--Spirit of Surgical Graft, Especially in the West--Fee-Splitting and Commissions--A Nation of "Dollar-Chasers"--The Public's Share of Responsibility--Senn's Advice--The "Surgical Conscience."

I think we have enough before us to show why intelligent people become followers of fads. Seeing so many impositions and frauds, they forget all the patient research and beneficent discoveries of n.o.ble men who have devoted their lives to the work of giving humanity better health and longer life. They are ready at once to denounce the whole medical system as a fraud, and become victims of the first "new system" or healing fad that is plausibly presented to them.

And here a question arises that is puzzling to many. If these systems are fads and frauds, why do they so rapidly get and retain so large a following among intelligent people? The answer is not hard to find. The quacks of these fad schools get their cures, as every intelligent doctor of the old schools knows, in the same way and upon the same principle that is so important a factor in medical practice, _i. e._, _faith cure_--the psychic effect of the thing done, whether it be the giving of a dose of medicine, a Christian Science pow-wow, the laying on of hands, the "removal of a lesion" by an Osteopath, the "adjustment" of the spine by a Chiropractor, or what not.

The principles of mind or faith cure are legitimately used by the honest physician. Suggestive therapeutics is being systematically studied by many who want to use it with honesty and intelligence. They realize fully that abuse of this principle figures largely in the maintenance of the shysters in their own school, and it is the very foundation of all new schools and healing fads. The people must be made to know this, or fads will continue to flourish.

The honest physician would be glad to have the people know more than this.

He would be glad to have them know enough about symptoms of diseases to have some idea when they really need the help of a physician. For he knows that if the people knew this much all quacks would be speedily put out of business.

I wonder how many doctors know that observing people are beginning to suspect that many physicians regulate the number of calls they make on a patient by motives other than the condition of the patient--size of pocketbook and the condition of the roads, for instance. I am aware that such imputation is an insult to any physician worthy of the name, but the sad fact is that there are so many, when we count the quacks of all schools, unworthy of the name.

The president of a St. Louis medical college once said to a large graduating cla.s.s: "Young men, don't go to your work with timidity and doubts of your ability to succeed. Look and act your part as physicians, and when you have doubts concerning your power over disease _remember this_, ninety-five out of every hundred people who send for you would get well just the same if they never took a drop of your medicine." I have never mentioned this to a doctor who did not admit that it is perhaps true. If so, is there not enough in it alone to explain the apparent success of quacks?

Again I say there are many n.o.ble and brainy physicians, and these have made practically all the great discoveries, invented all the useful appliances, written all the great books for other schools to study, and they should have credit from the people for all this, and not be misrepresented by little pretenders. Their teachings should be applied as they gave them. The best of them to-day would have the people taught that a physician's greatest work may be done in preventing rather than in curing disease. Physicians of the Osler type would like to have the people understand how little potency drugs have to cure many dangerous diseases when they have a firm hold on the system. They would have some of the responsibility removed from the shoulders of the physician by having the people understand how much they may do by hygienic living and common-sense use of natural remedies.

But the conscientious doctor too often has to compete with the pretender who wants the people to believe that _he_ is their hope and their salvation, and in him they must trust. He wants them to believe that he has a specific remedy for every disease that will go "right to the spot"

and have the desired effect. People who believe this, and believe that without doctoring the patient could never get well, will sometimes try, or see their neighbors try, a doctor of a "new school." When they see about the same proportion of sick recover, they conclude, of course, that the doctor of the "new school" cured them, and is worthy to be forever after intrusted with every case of disease that may arise in their families.

This is often brought about by the shyster M.D. overreaching himself by diagnosing some simple affection as something very dangerous, in order to have the greater credit in curing it. But he at times overestimates the confidence of the family in his ability. They are ready to believe that the patient's condition is critical, and in terror, wanting the help of everything that promises help, call in a doctor of some "new school"

because neighbors told how he performed wonderful cures in their families.

When the patient recovers speedily, as he would have done with no treatment of any kind, and just as the shyster M.D. thought he would, the glory and credit of curing a "bad case" of a "dangerous disease" go to the new system instead of redounding to the glory of Dr. Shyster, as he planned it would.

Is it any wonder true physicians sometimes get disgusted with their profession when they see a shyster come into the town where they have worked for years, patiently and conscientiously building up a legitimate practice that begins to promise a decent living, and by such quack methods as diagnosing cases of simple fever, such as might come from acute indigestion or too much play in children, as something dangerous, typhoid or "threatened typhoid," or cases of congestion of the lungs as "lung fever," and by "aborting" or "curing" these terrible diseases in short order and having his patients out in a few days, jumps into fame and (financial) success at a bound? Because the typhoid (real typhoid) patients of the honest doctor lingered for weeks and sometimes died, and because frequently he lost a case of real pneumonia, he made but a poor showing in comparison with the new doctor. "He's just fresh from school, you know, from a post-graduate course in the East." Or, "He's been to the old country and _knows_ something." Just as if any physician, though he may have been out of school for many years, does not, or may not, know of all the curative agencies of demonstrated merit!

Would a medical journal fail to keep its readers posted concerning any new discovery in medicine, or helpful appliance that promises real good to the profession? Yet people speak of one doctor's superior knowledge of the best treatment of a particular disease as if that doctor had access to some mysterious source of therapeutic knowledge unknown to other physicians. It is becoming less easy to work the "dangerous diagnosis"

graft than formerly, for many people are learning that certain diseases must "run their course," and that there are no medicines that have specific curative effects on them.

There is another graft now that is taking the place of the one just mentioned, to some extent at least. In the hands of a fellow with lots of nerve and little conscience it is the greatest of them all. This is the graft of the smart young fellow direct from a post-graduate course in the clinics of some great surgeon.

He comes to town with a great flourish of trumpets. Of course, he observes the ethics of the profession! The long accounts of his superior education and unusual experience with operative surgery are only legitimate items of news for the local papers. Certainly! It is only right that such an unusual doctor should have so much attention.

There is no "starving time" for him. No weary wait of years for patients to come. At one bound he leaps into fame and fortune by performing "big operations" right and left, when before his coming such cases were only occasionally found, and then taken to surgeons of known ability and experience. The reputable physician respects surgery, and would respect the bright young fellow fresh from contact with the latest approved methods who has nerve to undertake the responsibility of a dangerous operation when such an operation is really indicated. But when it comes to mutilating the human body by cutting away an appendix or an ovary because it is known that to remove them when neither they nor the victim are much diseased is a comparatively safe and very _quick_ way to get a big reputation--that is the limit of quackery. And no wonder such a man is so cordially hated by his brethren. He not always hated because he mutilates humanity so much, as because his spectacular graft in surgery is sure to be taken as proof conclusive that he is superior in all other departments of therapeutics.

And it puzzles observing laymen sometimes to know why all the successful (?) operations are considered such desirable items of news, while the cases that are not flattering in their outcome pa.s.s unmentioned.

I find most complete corroboration of my contention in the president's address, delivered before the Western Surgical and Gynecological a.s.sociation at St. Louis, in 1907, by Charles W. Oviatt, M.D. This address was published in the _Journal of the American Medical a.s.sociation_, and I herewith reprint it in part:

"The ambitious medical student does not usually get far into college work before he aspires to become a surgeon. He sees in the surgical clinics more definite and striking results than are discernible in other branches. Without being able to judge of his own relative fitness or whether he possesses the special apt.i.tude so essential to success, he decides to become a surgeon. There will always be room for the young surgeon who, fitted by nature for the work, takes the time and opportunity to properly prepare himself. There is more good surgery being done to-day than ever before, and there are more good surgeons being educated to do the work. If, however, the surgeon of the future is to hold the high and honorable position our leaders have held in the past, there must be some standard of qualification established that shall protect the people against incompetency and dishonesty in surgeons.

"That there is much that pa.s.ses under the name of surgery being done by ill-trained, incompetent men, will not be denied. What standard, then, should be established, and what requirement should be made before one should be permitted to do surgery? In his address as chairman of the Section on Surgery and Anatomy of the American Medical a.s.sociation, at the Portland (1905) meeting, Dr. Maurice H. Richardson deals with this subject in such a forceful, clear-cut way, that I take the liberty to quote him at some length:

"'The burden of the following remarks is that those only should practice surgery who by education in the laboratory, in the dissecting-room, by the bedside, and at the operating-table, are qualified, first, to make reasonably correct deductions from subjective and objective signs; secondly, to give sound advice for or against operations; thirdly, to perform operations skillfully and quickly, and, fourthly, to conduct wisely the after-treatment.

"'The task before me is a serious criticism of what is going on in every community. I do not single out any community or any man.

There is in my mind no doubt whatever that surgery is being practiced by those who are incompetent to practice it--by those whose education is imperfect, who lack natural apt.i.tude, whose environment is such that they never can gain that personal experience which alone will really fit them for what surgery means to-day. They are unable to make correct deductions from histories; to predict probable events; to perform operations skillfully, or to manage after-treatment.